摘要:
目的：观察卡培他滨单药或联合方案治疗蒽环及紫衫类化疗后转移的乳腺癌的临床疗效及毒副反应。方法：2007年7月~2014年6月贵州省肿瘤医院乳腺、妇科肿瘤科收治转移性乳腺癌20例，其中：锁骨上淋巴结转移4例，肺转移5例，骨转移4例，肝转移1例，脑转移1例，皮肤转移1例，对侧乳腺转移1例，多脏器转移3例。全组病例均行蒽环类或/和紫杉类药物辅助化疗。全组病例给予含卡培他滨单药或联合方案化疗。治疗前中位KPS评分90分。其中单药治疗2例；卡培他滨连用曲妥珠单抗2例；联合贝伐单抗1例；联合吉西他滨9例；联合顺铂1例；联合紫杉醇2例；联合多西紫杉醇3例；化疗周期数2~6周期，中位周期数：4周期。所有病例治疗后均根据RECIST实体瘤客观评价标准(1.0版)进行疗效评价，毒副反应按WHO抗癌药物毒副反应评价标准进行评价。结果：其中有1例因失访后未能进行疗效评价。可评价例数共19例，其中1例达CR；6例达PR；6例达SD；6例达PD，有效率为36.8% (7/19)。治疗后出现转移的时间为2~33月，中位无疾病进展时间(PFS)为13月。20例患者出现1例4度骨髓抑制，1例3级吐消化道反应，经对症治疗后好转，其余1~2级消化道反应患者均能承受。出现4例1~2级手足综合症。结论：以卡培他滨单药或联合方案对既往紫衫、蒽环类化疗失败的转移性乳腺癌患者有一定疗效，且不良反应可以耐受，可作为转移性乳腺期有效治疗方案。Objective: To observe the clinical curative effect, toxic and side effect after the treatment of anth-racene ring and Paclitaxel chemotherapy with capecitabine for the recurrence metastasis of breast cancer. Method: From July 2007 to June 2014, Guizhou tumor hospital’s breast and gynecological oncology section received and treated 20 patients with metastatic breast cancer, among which, there were 4 cases with neck and supraclavicular lymph node metastasis, 5 cases with pulmonary metastasis, 4 cases with bone metastases, 1 case with liver metastasis, 1 case with brain metastases, 1 case with skin metastasis, 1 case with contralateral breast transfer and 3 cases with systemic multiple transfer. All patients underwent anthracycline or/and taxane adjuvant chemotherapy. They were given capecitabine medicine or combination chemotherapy. The median KPS score before the treatment in full cases was 90. there were 2 cases with capecitabine medicine; 2 cases with Capecitabine combined with Trastuzumab; 1 case with Capecitabine combined with bevacizumab; 9 cases with Capecitabine combined with gemcitabine; 1 case with Capecitabine combined with cis-platinum; 2 cases with Capecitabine combined with TAX (taxol); 3 cases with Capecitabine combined with docetaxel; 2 - 6 cycles of chemotherapy, the median cycles: 4. For all patients, the objective evaluation criteria in solid tumors (RECIST version 1.0) was used to evaluate the curative effect, and adverse reaction was evaluated by the toxicity of anticancer drug WHO standard evaluation. Result: There was 1 case lost to evaluate because of failure to follow-up. There were 19 cases evaluable, among which, 1 case reached CR; 6 cases reached PR; 6 cases reached SD; 6 cases reached PD, the effective rate of 36.8% (7/19). Transfer time is 2 - 33 monthsafter treatment. The progression-free survival is 13 months. In 20 cases, 1 case had 4 degrees of bone marrow inhibition, 1 case had level 3 vomit gastrointestinal reaction, and they got better after symptomatic treatment; the remaining patients with 1 - 2 levels of digestive tract reaction could tolerate. There were 4 cases with 1 - 2 levels of extremities syndrome. Conclusion: The capecitabine multidrug therapy has certain curative effect on the metastatic breast cancer with failure of anthracene ring and Paclitaxel chemotherapy and the adverse reactions can be tolerated, so it is an effective treatment scheme.